European Journal of Case Reports in Internal Medicine https://ejcrim.com/index.php/EJCRIM <p><strong>The&nbsp;<span class="HPblu">European Journal of Case Reports in Internal Medicine</span>&nbsp;</strong>is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from&nbsp;<a href="http://www.efim.org/about/member-countries">33 European countries</a>.&nbsp;<br><br>The journal’s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field.&nbsp;<strong><br><span class="HPblu">EJCRIM&nbsp;</span></strong>welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight, contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors).&nbsp;<strong><br></strong>The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.<br><br> <strong>EJCRIM</strong> is peer-reviewed with single-blind review and freely accessible to all.</p> SMC media s.r.l. - Via Giovenale 7, Milan - Italy en-US European Journal of Case Reports in Internal Medicine 2284-2594 <h3>Copyright and Disclosures</h3> <p>Every author must sign a copyright transfer agreement and disclose any financial or professional interest in any company, product, or service mentioned in an article. This authorization includes all submitted text including illustrations, tables, and other related materials.<br> If this submission contains any <strong>material that has been previously published</strong>, this authorization <strong>must also be accompanied</strong> by all necessary Permission to Reproduce Published Material" forms completed by the current copyright owner. If this submission contains any <strong>previously unpublished material</strong> for which the person(s) signing this form <strong>does not own copyright</strong>, an additional "Authorization to Publish" form is required from each corresponding copyright owner.</p> <h3>Copyright Transfer Declaration</h3> <p>(this may be included as a word document with your manuscript submission)<br> I confirm that I am the current copyright owner of the material described above and hereby transfer and assign to the European Journal of Case Reports in Internal Medicine (EJCRIM) all copyrights in and to the material for publication throughout the world, in all forms and media, in English and in any other language(s). Such transfer includes publication in this and all future editions of the publication named above and in any other publications (including slide collections and any other nonprint media) of EJCRIM and gives EJCRIM the sole authority to grant rights for use of the material by others.<br> I waive EJCRIM from any liabilities connected to the incorrect copyright statement.<br>The copyright agreement form can be downloaded <a style="font-weight: bold;" href="/documents/EJCRIM_Copyright_auth.pdf">HERE</a> or requested to the editorial office <a style="font-weight: bold;" href="mailto:ejcrim@smc-media.eu">ejcrim@smc-media.eu</a></p> Antiphospholipid syndrome and Protein-losing enteropathy following Splenic Marginal Zone Lymphoma relapse: a case report https://ejcrim.com/index.php/EJCRIM/article/view/2450 <p>Splenic Marginal Zone Lymphoma (SMZL) is a low-grade B-cell non-Hodgkin's lymphoma (NHL) characterized by massive splenomegaly, moderate lymphocytosis with or without villous lymphocytes, and rare involvement of peripheral lymph nodes and usually an indolent course. Although not curative, splenectomy is a standard treatment in SMZL patients.&nbsp;&nbsp;</p> <p>Immune-mediated paraneoplastic phenomena are common in SMZL, being the Lupus Anticoagulant (LA) the most common. While LA interferes with both Prothrombin Time (PT) and Thromboplastin Time (aPTT) tests in vitro, it is associated with arterial and venous thrombosis rather than bleeding. Protein-losing enteropathy (PLE) is a rare complication of lymphoproliferative disorders.&nbsp;</p> <p>We report a case of a 71-year-old patient with a relapse of a previously diagnosed SMZL with both APS and PLE.</p> Pedro Vieira Andreia Póvoa André Silva Nadejda Potlog Mara Costa Joanne Lopes Rui Caetano Oliveira Rita Fernandes João Correia Copyright (c) Delayed recognition of Levetiracetam induced Pancytopenia https://ejcrim.com/index.php/EJCRIM/article/view/2449 <p>Blood dyscrasias associated with levetiracetam use can be difficult to identify especially when other potential differential diagnoses are concurrently present. Here we present a 57-year-old male with metastatic adenocarcinoma of unknown primary origin on levetiracetam who initially presented with an in-stent thrombosis of the right external iliac vein and then developed worsening thrombocytopenia followed by pancytopenia. Levetiracetam was not identified as the culprit until other causes like platelet consumption, heparin-induced thrombocytopenia, idiopathic immune thrombocytopenic purpura, and bone marrow involvement by metastatic disease were ruled out.</p> Mohammad Ammad Ud Din Syed Ather Hussain Amy Bodrog Copyright (c) Clinical Challenge In The Follow-Up Of A Long-Standing Granulomatosis With Polyangiitis https://ejcrim.com/index.php/EJCRIM/article/view/2448 <p>Granulomatosis with polyangiitis (GPA) is the most frequent antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). We describe a case of 38-year-old woman with a relapsing GPA that presented with intracranial hypertension, followed by the appearance of cavitated lung nodules despite treatment with azathioprine. Clinical improvement and ANCA titters reduction were observed after rituximab treatment. We aimed to report a rare form of GPA relapse and to highlight the challenge of the follow-up of patients with GPA, in which can be hard to distinguish a relapse from a consequence of a long-standing immunosuppression.</p> Andreia Diegues Copyright (c) THE GREAT MASQUERADER INTERRUPTED AORTIC ARCH PRESENTED AS ACUTE HEART FAILURE. https://ejcrim.com/index.php/EJCRIM/article/view/2446 <p>An interrupted aortic arch is a rare congenital malformation that occurs in 2 cases per 100000 live births and usually presents in the first weeks of life. Presentation in adulthood is infrequent but has been reported before. Early intervention is vital in early after birth. Atypically patients with IAA presents later in life with a complication from refractory hypertension. Recent advances in neonatal cardiac surgeries significantly improved the outcome.</p> Mohamed Magdi mohamed Eid Mahmood Mubasher Copyright (c) When A Hematoma Is The Tip Of The Iceberg https://ejcrim.com/index.php/EJCRIM/article/view/2445 <p>Anticoagulation therapy caries a risk of hemorrhagic complications. Management of patients needing these therapies requires an attentive and regular follow up. Among an unresolving hemorrhagic complication, such as an overgrowing hematoma with functional compromise of a limb should prompt careful investigation. In this particular case, the persisting hematoma and signs of rebleeding despite implemented measures, revealed being associated to a rare, infrequent tumor, particularly in adults, a rhabdomyosarcoma.</p> Dora Lameiras Xete Manuela Zita Veiga Isabel Madruga Copyright (c) An unexpected case of hepatic fascioliasis https://ejcrim.com/index.php/EJCRIM/article/view/2444 <p>Human fascioliasis is a rare trematode infection. Misdiagnosis is frequent as the clinical picture may be confused with other diseases. We describe one patient with eosinophilia and liver masses that was previously misdiagnosed with cholangiocarcinoma. The diagnosis was than reviewed as fascioliasis and the patient was successfully treated with triclabendazol.</p> João Fernandes Serodio Mónica Lopes Renata Ribeiro Miguel Trindade Catarina Favas José Delgado Alves Copyright (c) Sequential Coronary Vasospasm as Potential Cause of Acute Coronary Syndrome in Segments with and Without Obstructive Disease https://ejcrim.com/index.php/EJCRIM/article/view/2443 <p><strong>Introduction</strong>: Coronary spasm is a heterogeneous phenomenon that can occur in patients with or without obstructive coronary artery disease (CAD).</p> <p><strong>Aims: </strong>We describe a particular case of coronary vasospasm inducing thrombosis and ST-segment elevation myocardial infarction (STEMI)<strong>.</strong></p> <p><strong>Case presentation</strong>: A 42-year-old man was admitted to hospital for anterior STEMI with transient ST-segment elevation. Coronary angiography showed a non-occlusive fixed stenosis of the proximal left anterior descending (LAD) artery and an intraluminal filling defect in the right coronary artery (RCA). Optical coherence tomography showed a red thrombus in the RCA and no evidence of coronary atherosclerosis. Dual antiplatelet therapy and parenteral anticoagulant were started. A few days later, the patient developed inferior ST-segment elevation caused by vasospasm of the RCA during coronary angiography.</p> <p><strong>Conclusions</strong>: Coronary vasospasm was a likely cause of transient ST-segment elevation with STEMI in the LAD, affected by “significant” CAD, and subsequently in the RCA, unaffected by CAD. These data suggest that coronary vasospasm may sequentially trigger acute coronary syndrome both in the presence and absence of obstructive CAD.</p> Stefano Coiro Cristian Mattei Andrea Santucci Rocco Sclafani Francesca Scavelli Copyright (c) Capnocytophaga canimorsus in a patient with polymyalgia rheumatica. https://ejcrim.com/index.php/EJCRIM/article/view/2442 <p>Capnocytophaga canimorsus is a Gram-negative bacterium present in the oral cavities of cats and dogs. Most patients have a predisposing condition, frequently asplenia or alcohol abuse but also immune dysfunction of any kind, include due to steroid therapy. Sometimes, patients report a history of exposure to dogs without bites or scratches. Patients should be treated initially with a beta-lactam-beta-lactamase inhibitor combination, pending susceptibility testing. The duration of therapy should be based on the clinical presentation and the response to treatment.</p> Raquel Jaso Tejera Copyright (c) Right-side endocarditis – a typical presentation in an atypical patient https://ejcrim.com/index.php/EJCRIM/article/view/2436 <p>Right-side endocarditis (RSE) is a well-defined clinical entity, rarer than left-side endocarditis. It is frequently associated with intravenous drug use or presence of medical devices. The most frequent affected valve is the tricuspid valve. In most cases, the medical treatment is enough. Surgical treatment is reserved for failed medical therapy or in the presence of large vegetations. Although there is a high recurrence in intravenous drug users (IVDU), RSE has a good prognosis. We present the case of a 70-year old male without previous known diseases except from alcohol abuse. He was admitted with fever, cough, haemoptysis and loss of 8kg of weight in two months. Chest X-ray revealed two images of condensation, one in the right pulmonary base and another in the superior right lobe. The computerized tomography of the thorax revealed a subsegmental pulmonary embolism. The patient refused hospitalization and went home medicated with levofloxacin and apixaban. In ambulatory, there was a decrease in size of the lesions but with a new lesion in the right hemithorax. Two months after the first episode the patient is admitted with the same symptoms. The transthoracic echocardiogram showed a 20cm vegetation in the tricuspid valve. It was initiated treatment with penicillin and gentamicin after isolation of a <em>Streptococcus mitis</em> in the blood cultures. Surgical treatment was needed after a weak response to antibiotics, with a good evolution.</p> João Pedro Pais Ana Sofia Matos Ana Nascimento Ana Rita Cambão Diana Guerra Copyright (c) Invasive Mediastinal Mucormycosis with pulmonary and cardiac involvement in an adult with Chronic Granulomatous Disease; Case report and review of literature https://ejcrim.com/index.php/EJCRIM/article/view/2435 <p>Mucormycosis is a rare fungal infection that often causes rhinocerebral disease. However there have been rare cases of mediastinal involvement. These patients remain a therapeutic challenge and mortality in this group remains very high. We report a case of mediastinal mucormycosis with invasion of the heat and right lung in a patient with Chronic Granulomatous Disease (CGD) and also review the available literature on mediastinal mucormycosis.</p> Ashraf Nadeem Ali Wahla Ashraf Altarifi Copyright (c)